Papillary carcinoma masquerading as clinically toxic adenoma in very young children

Abstract

Background: Autonomously functioning thyroid nodules (AFTN) are extremely rare in children. Malignancy may be rarely found in hyperfunctioning ' hot ' nodules in adults. However, there are limited reports of AFTNs in young children presenting as or developing malignancy in future. We report here two young children aged < 6 years old at the time of diagnosis as having an AFTN, which eventually turned out to be papillary carcinoma of thyroid (PTC) on follow-up. Patient fi ndings: A 2-month-old baby had a right-sided neck swelling since birth. On examination, the baby had clinical and biochemical features of thyrotoxicosis. On sonography, and subsequently on 99m Tc-pertechnetate thyroid scan, a hot nodule was found. Patient was treated with carbimazole for 5 years. In spite of euthyroidism achieved, the nodule continuously grew in size. Thyroid cytology was inconclusive, hence hemithyroidectomy was performed and histopathology turned out to be PTC. Another 5-year-old female child had a large right-sided AFTN on thyroid scan. She was treated with radioiodine; however, like the previous case, the nodule started growing in size. She subsequently underwent near total thyroidectomy and histology was reported as PTC. Conclusion: In the light of this report that shows that solitary hyperfunctioning nodules in very young children have high chance of malignancy, we recommend hemithyroidectomy as the treatment of choice.

Follicular Variant of Papillary Thyroid Carcinoma Presenting as Toxic Nodule in an Adolescent: Coexistent Polymorphism of the TSHR and Gsα Genes

“…Consequently, FNAB is not recommended (4). Nevertheless, malignancy may be found in AFTNs with non-negligible frequency in both adults and children (5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Thyroid Carcinoma in Hot Nodules: Review of the Literature

“…Out of these 31 articles, 16 articles (five series of cases and 11 case reports) included cases matching the previously mentioned criteria for a total of 45 reported cases. 6,7,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] Among these 45 cases, the histological repartition was as follow: 25 (56%) follicular carcinoma, 16 (36%) papillary carcinoma including at least four (9%) confirmed follicular variant, two (4%) Hürthle cells thyroid cancer, one (2%) poorly differentiated thyroid cancer and we were not able to find the histology for one case (Table 1).…”

“…Two articles suggested a higher prevalence of cancer in hot nodules in children. 13,25 Guidelines about the management of hot thyroid cancers were found in three articles, all of which were consensus articles from major surgical and medical associations. …”

“…All articles published before September 2012 were taken into consideration. According to previously published articles, [10][11][12][13] we defined the following three criteria to define true cases of hypersecreting thyroid carcinoma: localized increased radioactive marker uptake on scintigraphy, decreased TSH levels and complete coincidence on histopathologic examination between the hypersecreting thyroid tissue and the thyroid carcinoma. Cases matching all three criteria were then compiled, including authors, date of publication, number of cases and histopathology of thyroid cancer.…”

Management of hyperthyroidism in children

“…In fact, the risk of a malignant evolution over time is not negligible, as also suggested by the several cases of primary thyroid carcinoma that were recently described in children suffering from HTNs [78][79][80][81].…”